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A service evaluation and improvement project: a three year systematic audit cycle of the physiotherapy treatment for Lateral Epicondylalgia

Abstract

Objectives

To improve outcomes of physiotherapy treatment for patients with Lateral Epicondylalgia.

Design

A systematic audit and quality improvement project over three phases, each of one year duration.

Setting

Salford Royal NHS Foundation Trust Teaching Hospital Musculoskeletal Physiotherapy out-patients department.

Participants

n = 182.

Interventions

Phase one — individual discretion; Phase two — strengthening as a core treatment however individual discretion regarding prescription and implementation; Phase three — standardised protocol using high load isometric exercise, progressing on to slow combined concentric & eccentric strengthening.

Main outcome measures

Global Rating of Change Scale, Pain-free grip strength, Patient Rated Tennis Elbow Evaluation, Tampa Scale of Kinesophobia-11.

Results

Phase three demonstrated a reduction in the average number of treatments by 42% whilst improving the number of responders to treatment by 8% compared to phase one. Complete cessation of non-evidence based treatments was also observed by phase three.

Conclusions

Strengthening should be a core treatment for LE. Load setting needs to be sufficient. In phase three of the audit a standardised tendon loading programme using patient specific high load isometric exercises into discomfort/pain demonstrated a higher percentage of responders compared to previous phases.

Cite this article

A service evaluation and improvement project: a three year systematic audit cycle of the physiotherapy treatment for Lateral Epicondylalgia.
 

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